沈阳市1984-2006年肾综合征出血热流行趋势分析

发布时间：2018-07-17 03:50

【摘要】： 目的:沈阳市是受汉坦病毒危害比较严重的地区之一,自1958年发现首例HFRS,疫情不断蔓延,近年来,出血热疫情呈不断上升趋势,流行范围广泛、危害严重,已经成为一个重要的公共卫生问题。本研究对沈阳市1984-2006年HFRS流行趋势进行分析,掌握其流行规律,为控制发病,减少死亡,制定有效防治措施提供科学依据。方法: 1.利用1984-2006年沈阳市传染病订正年报表、沈阳市人口资料、沈阳市HFRS监测总结,收集此时期内沈阳市HFRS地区、季节、人群分布特征、宿主动物的鼠种构成和密度、鼠类带病毒率、健康人群抗体水平等流行病学资料。 2.采用描述性流行病学方法,运用EXCEL表格、SPSS11.0进行数据整理和分析。采用率与构成比、动态数列进行描述,卡方及卡方趋势检验,线性相关与回归进行比较、相关与预测分析。结果: 1.1984-2006年沈阳市HFRS年均发病率5.17/10万,年均死亡率0.035/10万,病死率3.25%。 2.80年代HFRS疫情季节分布呈明显单峰型,冬春季为发病高峰,90年代季节分布有轻微变化,2000年后开始出现明显的春夏季流行高峰。 3.全市13个区县(市)均有HFRS病例发生。80年代发病主要集中在郊区,90年代流行规律发生了变化,市区发病构成随着年代的增加逐渐上升,郊区发病构成逐渐减少。 4.HFRS各年龄组均有发病,20-49岁年龄组发病构成最高;男女发病比为4.73:1;发病以农民为主,其次是学生、工人和干部等,但农民所占比例逐年减少,同期城镇家务待业的发病比例有逐年上升趋势。 5.1984-2006年居民区平均鼠密度为7.00%,以褐家鼠为优势鼠种。野外平均鼠密度为8.57%,以黑线姬鼠为优势鼠种。居民区与野外鼠密度有显著性差异,居民区鼠密度有明显上升趋势,而野外鼠密度有明显下降趋势。居民区鼠带毒率6.48%,带病毒指数为6.73;野外鼠带毒率2.98%,带病毒指数5.05。居民区与野外鼠带毒率有显著性差异,居民区鼠带病毒率有明显上升趋势,而野外鼠带病毒率有明显下降趋势。6.健康人群平均隐性感染率2.53% 7.发病率与鼠密度呈正相关;发病率与带病毒指数呈正相关;隐性感染率与发病率、鼠密度、带毒指数无相关性。结论: 1.沈阳市1984-2006年HFRS发病率一直波动在较高水平,发病率曲线起伏较大,呈“中→低→中”趋势。疫区类型由80年代的姬鼠型疫区转变为以家鼠型病毒感染为主的混合型疫区。 2.市区与郊区、县区相比较HFRS发病比例上升。人群发病构成仍以农民为主,但家务待业人员发病比例上升。 3.居民区鼠带病毒率高于野外,居民区鼠密度、鼠带毒率均有上升趋势,表明居民区鼠间疫情仍然较重。发病率与鼠密度及鼠带毒指数呈正相关。
[Abstract]:Objective: Shenyang is one of the regions seriously damaged by Hantavirus. The first case of HFRSs has been discovered since 1958, and the epidemic situation has been spreading continuously. In recent years, the epidemic situation of hemorrhagic fever is on the rise, the epidemic range is wide, and the harm is serious. Has become an important public health problem. This study analyzed the epidemic trend of HFRS in Shenyang from 1984 to 2006, grasped its epidemic law, provided scientific basis for controlling morbidity, reducing death and making effective prevention and cure measures. Methods: 1. Based on the revised annual report of infectious diseases in Shenyang from 1984 to 2006, the population data of Shenyang and the monitoring and summary of HFRS in Shenyang, the distribution characteristics of HFRS, season, population distribution, the composition and density of host animals, the rate of rodent carrying virus were collected in this period. Epidemiological data such as antibody level in healthy population. 2. Using descriptive epidemiological method, the data were collected and analyzed by excel table SPSS 11.0. Ratio and composition ratio, dynamic sequence description, chi-square and chi-square trend test, linear correlation and regression comparison, correlation and prediction analysis. Results: 1. From 1984 to 2006, the average annual morbidity of HFRS in Shenyang was 5.17 / 100 000, and the average annual mortality rate was 0.035% / 100 000. The mortality rate of HFRS was 3.25. The seasonal distribution of HFRS in the 2.80 's showed a significant single-peak pattern. The seasonal distribution of disease peak in winter and spring was slightly changed in 1990s, and the obvious spring and summer epidemic peak began to appear after 2000. HFRS cases occurred in all the 13 districts and counties (cities) of the whole city. The incidence of HFRS cases mainly changed in the suburbs in the 1990s, and the incidence composition in the urban areas increased gradually with the increase of the years. 4. The incidence of HFRS was the highest in the 20-49 age group, the ratio of male to female was 4.73: 1. The incidence rate was mainly peasant, followed by students. Workers, cadres, etc., but the proportion of peasants has decreased year by year. During the same period, the incidence rate of household chores in urban areas increased year by year. 5. The average rodent density was 7.00 in the residential area from 1984 to 2006, with Rattus norvegicus as the dominant species. The field average density was 8.57, with Apodemus agrarius as the dominant species. There was significant difference between the density of rodent in residential area and that in field. The density of rodent in residential area increased obviously, but the density of rodent in field decreased obviously. The rate of carrying virus in residential area was 6.48, the index of carrying virus was 6.73, the rate of carrying virus in field mice was 2.98 and the index of carrying virus was 5.05. There was a significant difference between residential area and wild mice in the rate of carrying virus, the rate of carrying virus in residential area was obviously rising, while the rate of carrying virus of wild mouse had a significant decrease trend of .6. The average recessive infection rate was 2.53% in healthy population. The incidence rate was positively correlated with the rat density, the incidence rate was positively correlated with the virus carrying index, and there was no correlation between the recessive infection rate and the incidence rate, mouse density and virus carrying index. Conclusion: 1. From 1984 to 2006, the incidence rate of HFRS fluctuated in a higher level in Shenyang. The type of epidemic area changed from the Apodemus type epidemic area in the 1980s to the mixed epidemic area with the main infection of domestic mouse type virus. 2. 2. The incidence rate of HFRS in urban area and suburb was higher than that in county area. The incidence of population is still mainly farmers, but the proportion of household unemployed workers increased by 3. 3%. The rate of rodent carrying virus in residential area was higher than that in field, and the density of rodent and the rate of rodent carrying virus in residential area were all on the rise, which indicated that the epidemic situation of rodent in residential area was still serious. The incidence rate was positively correlated with the density of mice and the index of carrying virus.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R512.8;R181.3

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